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NPI Code Detail

MEDICARE: DR. STEPHEN CHRIS CLARK D.D.S.

MEDICARE:  DR. STEPHEN CHRIS CLARK  D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryOK 4100OK

General Provider Information

NPI Number : 1699717769
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN CHRIS CLARK D.D.S.
Provider Business Mailing Address
First Line : 7200 S PENNSYLVANIA AVE
Second Line : SUITE B
City : OKLAHOMA CITY
State : OK
Zip : 73159-3336
Country : US
Telephone Number : 405-681-6668
Fax Number : 405-682-6609
Provider Business Practice Location Address
First Line : 7200 S PENNSYLVANIA AVE
Second Line : SUITE B
City : OKLAHOMA CITY
State : OK
Zip : 73159-3336
Country : US
Telephone Number : 405-681-6668
Fax Number : 405-682-6609
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 06/03/2015

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Directions to “ DR. STEPHEN CHRIS CLARK D.D.S.” Practice Location

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